Episode #187

How To Be Comfortable Feeling Well

Everyone has different goals when they start CBT therapy. But feeling well is a change on its own, which can be hard to become comfortable with.

How can you use CBT to respond when feeling well starts to feel…uncomfortable?

How can you identify and counteract hot thoughts about feeling well?

Join me, Dr Julie Osborn, as we explore this fascinating and common result of doing the work and feeling better.

Click to listen now!

Full Episode Transcript

Hi, and welcome to My CBT Podcast. This is Dr. Julie. I'm a Doctor of Psychology and a licensed clinical social worker specializing in cognitive-behavioral therapy. I'm here to help you bring the power of CBT into your own life.

So thanks for joining me.

I hope everybody's doing well. I'm going to start off with an email that I thought would be helpful to share and let you know how I answered the listener's question. So this is somebody that struggles with generalized anxiety disorder and panic disorder.

So he says,

“Hi ma'am,

“I just found your podcast and it's amazing. I'm currently seeing a therapist and working CBT.

“However, I'm not sure with the in-between homework if it is adequate. Not sure if it's his specialty or not. I have been using Mind Over Mood to do my own CBT homework and as support in between sessions. I started having multiple panic attacks per week in 2022, and I was put on medication through the VA in January. I recently came off of Lexapro and started therapy and CBT in February.

“I bought Mind Over Mood in March and about to start Chapter 11. My panic was about me, and now I panic over my daughter's health. She is healthy, more of what if something happens to her. I wanted to know, can I do Mind Over Mood on my own to manage my anxiety and panic? I haven't had an ER panic attack since January but have similar episodes of panic in February and April.

“I say it was an improvement I did not call 911. However, I'm not sure if I worked through breaking the what-if cycle correctly and if it's normal to fall in and out of spirals at the beginning. Thank you for your thoughts. I appreciate any help recommendations.”

So that's great.

I mean, I think a lot of people can relate to his questions and what he's going through.

And I will just read to what I responded. So I just said, thanks for reaching out. I appreciate your kind words about my podcast. Yes, you can work through Mind Over Mood on your own. I'd also recommend a book called When Panic Attacks, which is by Dr. David Burns.

I would say it is normal to fall in and out as you're learning the tools. Although it does sound like you're making a lot of progress, which is wonderful. I'm glad my podcasts have been helpful. I would recommend Don't Panic, one of my podcasts, if you haven't listened to, and Health Anxiety and CBT as well. I discussed with him Chapter 14 of the Mind Over Mood book, which is called Understanding Anxiety, would be a good one to read.

Talked about how it's great he's so motivated and wanting to learn. And let me know if I can answer any questions.

And again, just wanting to— which I'm going to talk about today actually— that it's normal to kind of go back and forth. And you know, as you're working on learning the tools regarding back and forth— sorry, regarding your moods and how you're feeling— it's not just, oh, I learned this and now I'm fine, right? That it's, you know, it's an ebb and flow, shades of gray. And until you really start getting past the panic and alleviate that and dealing with your anxiety and feeling comfortable using the tools. So I hope this was helpful.

I think it was a great question. Again, I appreciate when you guys reach out to me, ask me great questions like this so I can share them with all of my listeners and everyone gets some really good answers. So, um, the Mind Over Mood book also, um, I do want to say that you can definitely work on your own. Any of the books I recommend, Dr. David Burns' book on feeling great. All these you can work through on your own.

I just tell everybody, when you do have a therapist, 'cause a lot of my clients see this, that when we're working together, we can get a little deeper, or much deeper I'd say, than sometimes just working it on your own, just because it's my specialty and I can ask certain questions you might not have thought of on your own. So, you know, go get the books if you don't have a therapist, for sure. It's a great place to start. If you feel you need more help, you could always seek someone out at that point. So that's what I wanted to share.

So today what I wanted to talk about, again, it talks a little bit about when he's like, you know, the back and forth is that being comfortable once you are well. So I know that's where all we all want to get to. I just want to be well, right? I want to be well. I hear that from my clients all the time.

I want them to be well. And then when people get to that place they've been working towards, right, and their mood is stable and they have all these great tools, sometimes they feel a little uncomfortable. I say especially people with anxiety, that they'll notice like, oh, I'm like okay right now, should I be worried about something, right? It's almost this bad habit, and it's a common challenge when you're in recovery that you become so accustomed to monitoring your symptoms, using your coping strategies, and preparing for setbacks that when you do feel well, it can actually feel, you know, unfamiliar. So the CBT can help not only with managing your distress, but also with adjusting to wellness.

And I thought this is a really great topic, not just anxiety, depression, whatever you're feeling, whatever mental health issues you're having, working on, things you're going through, life changes, all of this, it covers everything.

So let's talk about what you can do when you do feel uncomfortable, right? When being well feels uncomfortable, it's a real thing. I know it might sound odd, but it happens often. So you might notice that you have negative thoughts such as, you know, what if this doesn't last? I'm probably just fooling myself.

If I stop monitoring myself, I'm gonna relapse. I shouldn't feel this good. When there are still other problems in my life, and maybe something like bad must be around the corner, right? Or, or a lot of my clients say, I'm just waiting for the other shoe to drop, right? So these thoughts can create anxiety for you even when your symptoms have improved.

These are all really hot thoughts, right? So instead of saying, you know, what if this doesn't last, that you're really telling yourself it's not going to last, and you are fooling yourself. You know, and I can't stop monitoring. I gotta check in, check in, check in, right? And that because I still have problems in my life, I shouldn't feel this good, right?

I mean, they're all hot thoughts because just because you are feeling good, it doesn't mean everything's perfect, right? We're looking for progress, not perfection. So with CBT, right, I'm going to encourage you to examine whether these thoughts, right, are hot thoughts or facts. Right? Are you predicting that something bad's gonna happen?

Right? So your, your hot thought might be, you know, I'm feeling better, but I know I'm eventually gonna crash again. So we wanna say, okay, if that's your hot thought, what evidence do you have to support this? Right? What evidence do I have that doesn't support this?

Am I predicting the future as though it is certain? And what are the skills I've developed that I didn't have before that's really gonna make the difference? Right? That's part of your evidence that doesn't support this. Is now I have tools, I have skills.

I'm, I'm my own therapist now, right? Hopefully, you know, my CBT podcast has taught you to be your own therapist. So then when you have your moments, oh yeah, I have my tools that I'm going to use, and I'm doing thought records every day in my head because I got too many thoughts, right? Like everybody else, we all have too many thoughts. So you want to ask yourself, right?

So again, what evidence do I have that supports Right, that I'm feeling better, but I, I know eventually I will crash again. You know, that hot thought sounds so true. What evidence do I have that I can maintain my progress? Right, so, you know, how long have I been feeling well? What has worked for me?

What are other situations that I did feel a little anxious and I was able to kind of nip it in the bud by identifying my hot thought and looking for the evidence? Am I predicting the future as though it's going to be uncertain? You know, am I making assumptions? Right? Those I need to address also.

And again, looking over my skills that I have now, right? My basket of tools, my CBT tools that I can use. So a balanced thought for everything I just said could be, you know, I can't guarantee I won't struggle again, but now I have tools, insight, and experience that I can help myself. When I'm feeling this way. And all of these things also can help me handle future challenges.

And I can handle whatever comes my way. That's the belief I want my clients to walk away with. I can handle whatever comes my way. Because when I believe that, then I don't need to worry what's going to come my way, because I'll just handle it when it does show up, right? That's really changing that belief about how you see yourself, your feelings, your tools, all of those things.

Because you have the tools, the insight, and the experience. And those are all really, really important and can just really increase our own self-confidence. So we want to move from crisis management to living our lives, right? So when you have spent months or years focused on your symptoms, they can unintentionally organize their lives about your life— I'm sorry, about just avoiding distress, right? So when you're spending months or years— I'm going to say that again in a better way— focused on your symptoms, you can organize your life around that, right?

I'm going to avoid all these different things, right? Or I'm going to be hyper-focused on all these different things. So when you're in recovery, how am I going to move from crisis management to living? You want to shift your attention towards other things. You don't have to think about your anxiety all the time or your depression or your OCD symptoms or your pet, you know, bad relationships or difficult people in your life, right?

You want to move your attention towards having meaningful relationships, creating hobbies and interests. What are your personal goals for yourself now? 'Cause you know, your mental health isn't getting in the way. What's work look like? Do you want to do some volunteering, right?

How can you be more creative and how can you grow, right? So if CBT is part of your life, you want to ask yourself, you know, if anxiety, depression, or any other mental health issue are no longer running my life, they're not running the show anymore, what would I spend my energy on? Because I've spent so much energy just trying to be well. And hopefully that goal for you becomes building a life, not just preventing symptoms. So ask yourself, if my anxiety is no longer running the show, what do I want to spend my energy on?

If my depression is no longer running the show, any of my mental health issues, if toxic people in my life are now running the show because I've moved on and I've set healthy boundaries and I've learned to honor myself, what am I going to spend my energy on? Building a life that you deserve and that you want. And you want to let go of that excessive monitoring. So I know when you're in therapy or when, you know, when you're, you know, even listening to my podcast, learning the tools, I'm saying, okay, let's be in tune. We want to be in tune to our feelings so we can figure out what our thoughts are and if they're hot thoughts and all that good stuff.

Right? But now we're getting better and we want to start stepping away from that a little bit, that we want to be mindful. How am I feeling? What are my thoughts? But I'm not like checking all the time, right?

And during difficult periods when you're monitoring your thoughts, your moods, your triggers, that can be really helpful, of course, helpful in learning the tools. But once you're stable, excessive self-checking can actually become counterproductive.

So some examples might be, you know, if you're constantly scanning for signs of relapse, you know, or if you're analyzing every mood you're having. Uh-oh, I'm feeling a little nervous now. Oh, I'm a little sad. I'm hyperfocused on something. Uh-oh, what's going on?

Or if you repeatedly ask yourself, am I okay? Am I okay? Is anything wrong? How am I feeling? And if you're treating normal emotional ups and downs as evidence of mental distress.

Those are some examples when you're doing the excessive monitoring. I've known people that, you know, I say you wake up in the morning, you do like this body scan. How am I feeling? Is there anything wrong? And then you hyperfocus on that.

We want to get away from that, right? So part of CBT, you want to recognize that, you know, we all experience changing moods because we're human beings. So feeling sad, stressed, frustrated, or worried occasionally does not mean that our recovery is not in place. And when you're well, it actually includes being flexible and not having perfect emotional stability, right? Again, we want to— I don't even like using that word perfect.

I'm looking for progress. None of us are— have this perfect emotional stability. I don't even know what that would look like. Sounds like a robot actually to me. But you want to recognize we— that's where we want to get to, right?

That it's normal that I have different moods, It's normal that when I feel negative moods, it doesn't mean I'm relapsing. It's just I'm a human being and it mean— makes sense to feel all of my moods, right? And my wellness includes being flexible, and that's really important. So you always want to be building confidence in your CBT skills, right? That's why I ask all my clients, practice, practice, practice.

I use them every day, every day, every day. I practice what I preach. And because of that, I have a lot of confidence in my skills. I know that I can use my tools when I really, really need them. And that makes me feel calm and confident, right?

And in a good stable mood because I'm not worried about what might happen. So instead of asking yourself, you know, how can I make sure I never have symptoms again? I want you to say, how can I trust myself to respond effectively if symptoms return? Okay, so I'm going to say those two again. So instead of saying, how can I make sure I never have symptoms again, I want you to say, how can I trust myself to respond effectively if symptoms do return?

The shift moves you from seeking certainty to building confidence. Seeking certainty feeds anxiety and any other symptoms you might have because life is uncertain, right? I know a lot of people say, oh, that's unfortunate, but I, I'm like, you know, life being uncertain actually makes it exciting and, you know, I think feeds our, you know, curiosity and wants us to be driven. Because if we knew everything. If life was certain, I mean, really, in being honest, it'd be very boring.

If I knew it was going to happen tomorrow, tonight, in 5 years, you know, I would say, you know, we can plan for it, but who knows what's going to happen? And I want surprises and new things to come into my life that I didn't expect. I mean, that's what keeps life exciting, right? But a lot of people want certainty. People, anxious people, I'll say, want certainty, right?

I want to know I'm never going to feel bad. I want to make sure everything's going to work out, that person's never going to leave me. Like, instead, I want you to build confidence that if those things happen, if symptoms return, if bad things happen in your life, I have the confidence that I can handle it because I have all these great tools. So let's go over a recovery-oriented thought record. That's what I like to call it.

Okay, so when you notice fear about being well, This would be a great thought record to do. So a situation could be that, you know, I'm feeling stable right now and I'm having a great week, but then my hot thought, this won't last. No, no, no, it's not gonna last. So I'm feeling anxious. I'm gonna rate that about 60%, right?

What's my evidence that this won't last? Me having a good week and feeling stable. Well, one piece of evidence I could put down is, you know, I have struggled before. That is true. And evidence against the hot thought is that I've also recovered before.

I'm using healthy habits. I have coping skills. My current situation is different. I've created an action plan, so if things come up, I know what I'm going to do. I have my bucket of CBT tools that work best for me, and I can always go to them.

So your balanced thought would be that, you know, I can't predict the future, What I do know is that I'm doing well today, and I have resources and tools to help handle future challenges. That sounds really nice, huh? I hope just hearing that you can kind of, ah, take a breath, relax, and be like, this is what I've been working towards. It's okay that I'm a little, like, not comfortable yet, but I'm being well, but I'm going to keep working towards that and recognize that when I have a hot thought of possibly this won't last or I'm going to relapse, that you can look at all of this evidence I've just shared and become able to come up with this balanced thought, which I will say again is that I can't predict the future, but what I do know is I'm doing well today and I have resources and tools to handle future challenges. That is 100% true.

And that's where I want you guys to get to, right? So this is what, again, I call the recovery-oriented thought record. I'm actually in recovery. I'm actually doing well. Why am I still worried about not doing well?

You know, because I'm normal and the thought comes up. But I have to remind myself, what have I done to get to the place I am today? And what is helping me be here? I'm using all my tools. I'm remembering all the evidence.

I'm remembering all the things I've gotten through that were difficult, that, you know, show that I am brave and courageous and resilient, and I can be that way again if I need to be.

So a good principle with CBT, with recovery, is that it's not usually measured by the absence of all your symptoms, but it's actually measured by increasing your confidence that you can handle life, including difficult emotions, without being controlled by them, right? I always tell everybody, you want to manage your emotions and not let your emotions manage you. So again, it's not measured by the absence of symptoms. I think that's what we're all looking for. I don't want to feel this.

I don't want to feel this. I don't want to feel this. I want this to go away. Then I'll be doing well. It's actually measured by increasing your confidence that you can handle life, including difficult emotions, without being controlled by them.

So being comfortable with wellness often means learning to trust yourself more than you trust your fears. I'm going to say that again. Being comfortable with wellness often means learning to trust yourself more than you trust your fears. CBT helps by challenging those catastrophic predictions and strengthening the belief that you can cope effectively whether life is easy, difficult, or somewhere in between. Kind of makes me a little teary just thinking about like, oh, that's the place that I want all of you to be.

That's the place I've worked to get to. I'm comfortable being well because I trust myself that I can handle whatever comes my way. That is my truth, and that can be your truth. And the more you work on yourself and practice your CBT tools and figure out what works best for you and create the life you want, whether that's having to change your environments, you know, um Taking better care of yourself, dealing with your health, getting out of toxic relationships, changing work, you know, figuring out why am I so anxious, addressing the trauma you've had. All of these things can get you to a place of wellness and for you to be comfortable there.

That is the goal. That is what we're working towards. And having the CBT tools is what can get you there. We all have to have tools. Talking about things and even having insight doesn't always change.

A lot of people have good insight, but they still don't know what to do to make that change, right? Talking through things is really helpful, and it's just good to kind of vent sometimes, but you still need tools so when the issues in your life come up or the symptoms show themselves, you know you can manage it, right? We're going to have, I guess, quote, symptoms. I'll say when we're feeling our normal feelings through life's normal situations. And we want to know that I can walk through this.

Might be scary, it might be uncomfortable, but I know I can do it. I've done it before, and I actually have tools to walk me through that.

So, you know, share with me, get back to me, let me know. Is this something that maybe you didn't even identify? Like, oh, I'm actually a little uncomfortable being well. I'm still checking, you know, for things. I'm still being like, oh, you know, I need to be a little nervous because something's going to, you know, show up and I'm not going to see it.

I don't need to because I'll deal with it if it does. But is that your thought process, right? Do you worry that, you know, with your depression, if you're sleeping in one day, like, oh no, that's a sign? Not really. Let's, you know, step back and look at what's going on.

Maybe you're a little just tired. Maybe Maybe that was your symptom of sleeping too long and being in bed. You can check in with yourself, but not to go to that catastrophic place of like, oh no, no, no, here it is again, right? What's normal? We don't really know what's normal.

I tell my clients all the time, you know, when you've been anxious or depressed or whatever you're going through for, for years, a lifetime sometimes, you don't even know what normal is. So that's something for us to talk about. And as you know, what is your normal? What is normal? What do you want your normal to be?

And how can I be comfortable in that space? You know, that's just another part of your relapse prevention. I have a podcast on relapse prevention, talks about specific steps. This is a little bigger than that. My relapse prevention would be maybe, you know, getting comfortable with being well, because I just wanted to get well and I never thought about being uncomfortable in that spot, right?

If I said to someone, you know, just know near the end of therapy when you're feeling well, you might not be comfortable there, and they'd be like, what are you talking about? I'm dying right now. I just want to get better. That's why I'm here. And I'm like, okay, you know, let's wait till we get there and we'll explore that.

But again, it's normal. It's not strange. It's not weird. But I don't think a lot of people talk about it. They just want you to— oh good, you're well.

Good, now we can move on. What do we need to do to stay there and be okay with that? So as always, I hope this podcast was helpful. I hope you got to think about things differently. Share with someone that maybe be struggling as well.

I love to hear from you guys. You can find me on my website at mycognitivebehavioraltherapy.com.

You can always email me at mycbtpodcast@gmail.com.

You can find me on Facebook, YouTube, and TikTok under Dr. Julie Osborne. And Instagram, I'm on My CBT Podcast where you can find me. So I know that's a lot. If you do listen to Apple Podcast, please, uh, click and subscribe. I'd love for you to write me a review.

It really gets the podcast out there to more people. And again, I really appreciate you taking the time not just to listen to my podcast, but to work on yourself. Give yourself that love, that respect that you deserve to be in a better place, to be happy, to enjoy your life.

And you can definitely get there using my mantra by making decisions based on what's best for you, not how you feel.